There are approximately 20 million people who take thyroid medication. Current research indicates that an additional 13 million Americans may be undiagnosed for low thyroid function. Why are so many left undiagnosed? One reason may be inadequate testing for thyroid hormone levels and the sole reliance by medical practitioners on these lab results for a diagnosis despite the patient’s symptoms. Most practitioners will only look at the TSH (thyroid stimulating hormone) and not the level of the individual thyroid hormones. It also recognized that the reference range for the TSH is simply too high leaving many people with low thyroid symptoms undiagnosed and, therefore, untreated.
Symptoms of Hypothyroid
Symptoms of low thyroid include fatigue and weakness, weight gain, intolerance to cold, dry skin, brittle nails, irregular menses, PMS, infertility and miscarriage, elevated cholesterol, depression and anxiety, decreased libido, headaches, dizziness, poor memory and difficulty concentrating, constipation, hair loss, joint pain and muscle stiffness. I have seen patients in my practice who present with a combination of these symptoms and have not been diagnosed with low thyroid function because their TSH falls within the normal range. A report in the Journal of the American Academy of Endocrinology revealed that the range for TSH is likely too broad. Numbers approaching the upper range of normal (4.25-5.0) may in fact be developing hypothyroid. My experience is that numbers above 2.0 may indicate a potential under activity of the thyroid.
How the Thyroid Works
The thyroid receives information from the pituitary gland in the form of TSH. This hormone stimulates the thyroid to produce the hormones T4 (thyroxine) and T3 (triiodothyronine). T4, which is relatively inert and T3, the more biologically active hormone are made by the body in a ratio of 90:10. This ratio provides a steady pool of T4 for conversion to T3 at the cellular level as needed by the body. Once T3 enters our cells it activates enzyme pathways that increase energy production, protein synthesis, fat and carbohydrate breakdown, increased tissue oxygenation and mineral utilization. Thyroid hormone activates over 100 enzymes to mediate a host of normal bodily functions. In fact, the brain, heart, lungs, intestines, sex glands and muscles owe much of their function to adequate thyroid hormone levels.
When it comes to blood tests, a more thorough assessment of thyroid function would include a Highly Sensitive TSH, Total T4, Free T4 and Free T3. It is very important to look at the free fraction of the hormone because it is metabolically active while those that are bound as in the total measurement are inactive. If the TSH is high, thyroid function is low. If the free fraction of the hormones is low, thyroid function is low. If all of these values fall within a marginally normal range but a patient is still symptomatic, another way of assessing thyroid function is by doing basal body temperatures. This involves taking an axillary (armpit) temperature before getting out of bed in the morning for 5-7 days. If the average temperature is below 97.6 then you may be low thyroid.
The Adrenal/Thyroid Connection
The symptoms of low thyroid are very similar to those of low adrenal function and the two glands must be adequately assessed because one can affect the other. The adrenal glands are positioned above the kidney and supply our bodies with the ability to deal with stress by releasing cortisol. Cortisol helps to maintain adequate blood sugar levels, mobilizes fat stores, produces an anti-inflammatory effect on body tissues, effects blood pressure, reproductive function, electrolyte balance, sex hormone production, mood and energy level. If you are in a constant state of stress, the adrenals may put out an elevated amount of cortisol. The effect on the thyroid is to slow it down. The reason this occurs is because too much cortisol can break down bone and tissue and, as a result, the thyroid slows down to decrease the rate of this reaction. Cortisol has an important role but it should not stay elevated over long periods of time.
The adrenals can be tested by taking 4 salivary samples throughout the course of a single day at designated times. Cortisol has a diurnal rhythm and is highest in the morning and lowest at night. The adrenals also produce DHEA (dehydroepiandrosterone) which is a precursor to testosterone and estrogen. When the adrenals are fatigued, the balance between cortisol and DHEA is altered. This can lead to an imbalance in sex hormone production. An adrenal test also measures the level of DHEA which helps to determine the degree of adrenal fatigue. A popular adrenal test I perform is called the #201 (Functional Adrenal Stress Profile) from BioHealth – www.biohealthinfo.com
Treatment of Low Thyroid and Adrenal Function
The typical treatment for low thyroid is a prescription for thyroid medication. There are a number of different types out there – both synthetic and natural. Everyone’s physiology is different and, therefore, one’s response may vary on different medications. A formulation that contains both T4 and T3 seems to work the best especially if it is delivered in the ratio that the body naturally produces. If one has adrenal fatigue, a balanced, nutrient-rich diet, hormone precursors, herbs, stress response modification and rest will remedy the situation. In treating both, an appropriate supplement program to aid the function of both glands is essential.